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Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

By |September 27, 2015|Chiropractic Research, Low Back Pain|

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

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SOURCE:   Int J Ther Massage Bodywork. 2015 (Sep 1); 8 (3): 16–33 ~ FULL TEXT


Richard A. Deyo, MD, MPH, Samuel F. Dworkin, DDS, PhD,
Dagmar Amtmann, PhD, Gunnar Andersson, MD, PhD,
David Borenstein, MD, Eugene Carragee, MD,
John Carrino, MD, MPH, Roger Chou, MD, Karon Cook, PhD,
Anthony DeLitto, PT, PhD, Christine Goertz, DC, PhD,
Partap Khalsa, DC, PhD, John Loeser, MD, Sean Mackey, MD, PhD,
James Panagis, MD, James Rainville, MD, Tor Tosteson, ScD,
Dennis Turk, PhD, Michael Von Korff, ScD, and Debra K. Weiner, MD

Oregon Health and Sciences University,
Portland, OR.


Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients’ lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement.

KEYWORDS: &nbsp NIH Task Force; chronic low back pain; low back pain; minimum dataset; research standards


 

From the FULL TEXT Article:

Introduction

The Institute of Medicine recently estimated that chronic pain affects about 100 million adults in the United States, with an estimated annual cost of $635 billion, including direct medical expenditures and loss of work productivity. [3] Activity-limiting low back pain (LBP), in particular, has a world-wide lifetime prevalence of about 39% and a similar annual prevalence of 38%. [61] The majority of people having LBP experience recurrent episodes. [62] The use of all interventions for treating chronic LBP (cLBP) increased from 1995–2010, including surgery, pharmacological, and non-pharmacological approaches. Despite increased utilization, however, the prevalence of symptoms and expenditures has increased. [37, 70, 91]

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The First Research Agenda For the Chiropractic Profession in Europe

By |March 19, 2015|Chiropractic Research|

The First Research Agenda For the Chiropractic Profession in Europe

The Chiro.Org Blog


SOURCE:  Chiropractic & Manual Therapies 2014 (Feb 10);   22 (1):   9


Sidney M Rubinstein, Jenni Bolton, Alexandra L Webb, and Jan Hartvigsen

Department of Health Sciences,
Faculty of Earth and Life Sciences,
VU University, Amsterdam,
1081 HV Amsterdam, The Netherlands.
S.M.Rubinstein@VU.nl


BACKGROUND:   Research involving chiropractors is evolving and expanding in Europe while resources are limited. Therefore, we considered it timely to initiate a research agenda for the chiropractic profession in Europe. The aim was to identify and suggest priorities for future research in order to best channel the available resources and facilitate advancement of the profession.

METHODS:   In total, 60 academics and clinicians working in a chiropractic setting, and who had attended any of the annual European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day meetings since their inception in 2008, were invited to participate. Data collection consisted of the following phases: phase 1 identification of themes; phase 2 consensus, which employed a Delphi process and allowed us to distill the list of research priorities; and phase 3 presentation of the results during both the Researchers’ Day and a plenary session of the annual ECU Convention in May 2013. In addition, results were distributed to all ECU member countries.

RESULTS:   The response rate was 42% from phase 1 and 68% from phase 2. In general, participants were middle-aged, male and had been awarded a Doctor of Philosophy (PhD) as well as chiropractic degree. Approximately equal numbers of participants had obtained their chiropractic degree from the UK/Europe and North America. The majority of participants worked primarily in an academic/research environment and approximately half worked in an independent institution. In total, 58% of the participants were from the UK and Denmark, collectively representing 44% of the chiropractors working in Europe. In total, 70 research priorities were identified, of which 19 reached consensus as priorities for future research. The following three items were thought to be most important:

1) cost-effectiveness/economic evaluations,

2) identification of subgroups likely to respond to treatment, and

3) initiation and promotion of collaborative research activities.

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Beyond the Spine: A New Clinical Research Priority

By |March 7, 2015|Chiropractic Research|

Beyond the Spine: A New Clinical Research Priority

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2015 (Mar);   59 (1): 6–12


James Donovan, BSc, DC, J.
David Cassidy, DC, PhD, DrMedSc,
Carol Cancelliere, DC, MPH,
Erik Poulsen, DC, PhD,
Mette Jensen Stochkendahl, DC, PhD,
Jørgen Kilsgaard, DC, MPH,
Marc-André Blanchette, DC, MSc, and
Jan Hartvigsen, DC, PhD

Division of Health Care and Outcomes Research,
Toronto Western Research Institute,
University Health Network,
University of Toronto, Canada


Over the past two decades, clinical research within the chiropractic profession has focused on the spine and spinal conditions, specifically neck and low back pain. However, there is now a small group of chiropractors with clinical research training that are shifting their focus away from traditional research pursuits towards new and innovative areas. Specifically, these researchers are now delving into areas such as brain injury, work disability prevention, undifferentiated chest pain, hip osteoarthritis, and prevention of pain in children and adolescents to name a few. In this paper, we highlight recent research in these new areas and discuss how clinical research efforts in musculoskeletal areas beyond the spine can benefit patient care and the future of the chiropractic profession.

KEYWORDS:   OA; brain injury; chest pain; chiropractic; research; work disability


 

From the FULL TEXT Article:

Introduction

Chiropractors with clinical research training have traditionally focused on the spine and its related disorders and especially neck and low back pain. Examples include the recent Decade of the Bone and Joint 2000–2010 Task Force on Neck Pain and Its Associated Disorders [1] as well as several excellent randomized trials of spinal manipulative therapy (SMT) for neck [2] and low back pain [3–5]. Despite these and many other research successes, from 1990 to 2010 disability from spine-related pain has significantly increased, with low back pain now the leading cause of global disability, affecting 10% of the population or more than 600 million people worldwide. [6] Over the same two decades, disability from other musculoskeletal disorders has also increased by 44.6% [7], and with an aging and increasingly sedentary society this trend is likely to continue and so too will the demand for improved care and prevention. Even patients seeking care for neck and low back pain rarely have pain isolated to just the spine and frequently report co-occurring non-spinal pain, not to mention other co-morbid diseases. [8] Chiropractors already commonly manage a variety of musculoskeletal disorders and at different anatomical sites, not just those related to the spine. Taken together, these facts provide a good basis to promote the growth of clinical research efforts in other non-spinal musculoskeletal areas.

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What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

By |July 15, 2014|Chiropractic Research, Low Back Pain|

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Dec); 20 (12): 2105-2110


Mark J. Hancock, Chris G. Maher, Mark Laslett, Elaine Hay, and Bart Koes

Faculty of Health Sciences,
University of Sydney,
PO Box 170,
Lidcombe 1825, NSW, Australia.
mark.hancock@sydney.edu.au


Purpose   Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain.

Methods   This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain.

Results   Six potential misunderstandings are discussed.

  1. Until diagnosis is shown to improve outcomes it is not worth investigating;
  2. without a gold standard it is not possible to investigate diagnosis of low back pain;
  3. the presence of pathology in some people without low back pain means it is not important;
  4. dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy;
  5. suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice;
  6. we seem to have forgotten the ‘bio’ in biopsychosocial low back pain.

Conclusions   We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Keywords:   Low back pain, Diagnosis, Back pain

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From the FULL TEXT Article

Introduction

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Current Trends in Chiropractic Research: An Interview with Malik Slosberg, DC

By |April 11, 2014|Chiropractic Research|

Current Trends in Chiropractic Research
An Interview with Malik Slosberg, DC

The Chiro.Org Blog


SOURCE:   Health Insights Today ~ March 2014 ~ FULL TEXT

Interview by Daniel Redwood, DC


Malik Slosberg, DC, lectures throughout the United States and internationally. A professor at Life Chiropractic College West who has received many awards as an outstanding instructor, including “Teacher of the Year,” he has also served on the postgraduate faculty of ten chiropractic colleges and was named “Chiropractor of the Year” by the Parker Resource Foundation.

Dr. Slosberg has been in private practice for thirty years, has published numerous articles in chiropractic journals and is currently a columnist for Dynamic Chiropractic. In addition, he has produced educational materials including videos, wall charts, and patient handouts used by many chiropractic colleges and thousands of chiropractors worldwide.

Slosberg holds a Masters of Science degree from California State University in clinical counseling and a Physicians’ Assistant degree from Dartmouth College.

Those who attended Dr. Slosberg’s lecture at Cleveland Chiropractic College’s Homecoming in 2013 know that he is an excellent communicator with a strong grasp of chiropractic-related research. Along these lines, he has recently (1) given a presentation to the clinic directors of all of the chiropractic colleges in the world at the Association of Chiropractic Colleges 2013 meeting, on “Integrating Exercise Training in the Chiropractic Curriculum and Clinical Experience; (2) served as guest editor of a peer-reviewed Journal of Electromyography and Kinesiology special issue on spinal manipulation; and been the first chiropractor invited to be a guest faculty member at the Annual Integrative Holistic Medicine Conference.

Tell us about your background in chiropractic practice and teaching, and as an analyst and interpreter of chiropractic-related research?

Before I was a chiropractor, I was a physician’s assistant. I was trained at Dartmouth Medical School and practiced for three years with an internist-gastroenterologist who was chief of staff at the Naples, Florida hospital. Eventually, I just got sick of prescribing medications so I looked for an alternative that was more natural. Someone recommended chiropractic and I went to school without knowing much about chiropractic. After graduating, I started teaching a course titled “Subluxation Pathology.” I started reading a great deal of the peer-reviewed research, since I hadn’t really been exposed to the scientific literature as a student. Reading the data that was out there, I soon realized that this was information that chiropractors should really know. But I didn’t see that it was well disseminated. So I began to teach this course and then the seminars. I also had a chiropractic practice for just under 30 years. Throughout that time, I was always a faculty member at a chiropractic college, first at Life in Georgia and then at Life-West, out in California.

What do you consider the most significant current trends in chiropractic-related research?

There are several that I think are quite significant. There are the recent high quality randomized trials evaluating the relative efficacy of chiropractic or spinal manipulation versus medical care, that is, versus anti-inflammatories, versus facet joint injections, and versus discectomies. This research has demonstrated that chiropractic is as effective or more effective, and often more cost-effective, than these more widely accepted medical interventions. This is important evidence and is being published in the areas of management of low back pain, neck pain, and also for headaches. Another area that I find really fascinating is the research on the impact of chiropractic on brain, including its influence on the sensory cortex, the motor cortex, and the cerebellum.

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The First Research Agenda for the Chiropractic Profession in Europe

By |February 15, 2014|Chiropractic Research|

The First Research Agenda for the Chiropractic Profession in Europe

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2014 (Feb 10); 22 (1): 9


Sidney M Rubinstein, Jenni Bolton, Alexandra L Webb, Jan Hartvigsen

Department of Health Sciences,
Faculty of Earth and Life Sciences,
VU University, Amsterdam,
1081 HV Amsterdam, The Netherlands


BACKGROUND:   Research involving chiropractors is evolving and expanding in Europe while resources are limited. Therefore, we considered it timely to initiate a research agenda for the chiropractic profession in Europe. The aim was to identify and suggest priorities for future research in order to best channel the available resources and facilitate advancement of the profession.

METHODS:   In total, 60 academics and clinicians working in a chiropractic setting, and who had attended any of the annual European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day meetings since their inception in 2008, were invited to participate. Data collection consisted of the following phases: Phase 1 identification of themes; Phase 2 consensus, which employed a Delphi process and allowed us to distill the list of research priorities; and Phase 3 presentation of the results during both the Researchers’ Day and a plenary session of the annual ECU Convention in May 2013. In addition, results were also distributed to all ECU member countries.

RESULTS:   The response rate was 42% from Phase 1 and 68% from Phase 2. In general, participants were middle-aged, male and had been awarded a Doctor of Philosophy (PhD) as well as chiropractic degree. Approximately equal numbers of participants had obtained their chiropractic degree from the UK/Europe and North America. The majority of participants worked primarily in an academic/research environment and approximately half worked in an independent institution. In total, 58% of the participants were from the UK and Denmark, collectively representing 44% of the chiropractors working in Europe. In total, 70 research priorities were identified, of which 19 reached consensus as priorities for future research. The following three items were thought to be most important: 1) cost-effectiveness/economic evaluations, 2) identification of subgroups likely to respond to treatment, and 3) initiation and promotion of collaborative research activities.

CONCLUSIONS:   This is the first formal and systematic attempt to develop a research agenda for the chiropractic profession in Europe. Future discussion and study is necessary to determine whether the themes identified in this survey should be broadly implemented.


 

From the Full-Text Article:

Introduction

Research involving chiropractors is evolving and expanding in several European countries while resources are limited. At the European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day in Zurich, Switzerland (June 2011), it was decided amongst the members that we needed to establish a vision for chiropractic research in Europe for the forthcoming five to ten years. This is in line with the results from a recent survey of all ECU member nations by the EAC Research Council. [1] Various other initiatives have also been conducted within the chiropractic profession, which include a strategic planning conference whose goal was to better service the public and at the same time promote the profession. [2]

There are three primary reasons why the instigation of a research agenda is believed to be important. Firstly, it is thought that the process could facilitate unity within the European chiropractic research community and encourage collaboration on research items considered to be important. Secondly, no European chiropractic research agenda has ever been established, which is in contrast to North America where an agenda was first established in 1997 [3] with an update in 2006 [4, 5]. Finally, researchers with chiropractic backgrounds frequently work and publish with other professionals, so it is of interest to investigate whether priorities from a chiropractic research agenda differ from other published agendas. For example, recently, a set of research priorities was established in the UK for non-pharmacological therapies for common musculoskeletal problems through a consensus process. [6]

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